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Urinary antispasmodics: Nursing Pharmacology

Notes

Notes

URINARY ANTISPASMODICS
DRUG NAME
tolterodine (Detrol), flavoxate HCl (Urispas), 
oxybutynin Cl (Ditropan), mirabegron (Myrbetriq)
CLASS
Urinary antispasmodics
MECHANISM OF ACTION
Relax the detrusor muscle by inhibiting the effects of the parasympathetic nervous system
INDICATIONS
Urinary tract spasms (urge incontinence, overactive bladder, urinary tract infection, injury)
ROUTE(S) OF ADMINISTRATION
  • PO
  • Topical
SIDE EFFECTS
  • Headaches, dizziness, drowsiness
  • Dry eyes, blurred vision
  • Dry mouth
  • Dry skin
  • Tachycardia
  • Nausea, vomiting, constipation
  • Urinary retention
CONTRAINDICATIONS AND CAUTIONS
  • Intestinal or urinary obstruction
  • Hypertension or cardiovascular disease
  • Narrow angle glaucoma
  • Myasthenia gravis
NURSING CONSIDERATIONS: URINARY ANTISPASMODICS
ASSESSMENT AND MONITORING
  • Baseline urinary assessment:  frequency, urgency, nocturia, incontinence
  • Vital signs, BUN, creatinine, renal function tests, urinalysis, urine culture
  • Side effects
  • Therapeutic response
CLIENT EDUCATION
  • Purpose of medication

Self-administration
  • Take exactly as prescribed
  • Swallow whole, do not crush or chew, take with or without food
  • Transdermal patch application

Side effects
  • Blurred vision, dizziness or drowsiness: avoid activities that require alertness
  • Dry eyes: administer lubricating eye drops
  • Dry mouth: sip water, sugar-free lozenges, or gum
  • Constipation: increase fiber, physical activity
  • Decrease urinary frequency, incontinence: empty bladder regularly, pelvic floor strengthening exercises, avoid caffeine
  • Report
    • Signs / symptoms of increased blood pressure; e.g., headaches, dizziness,  change in vision
    • Trouble emptying their bladder
    • Anxiety, restlessness, confusion
Transcript

Urinary antispasmodics are medications that can be used to reduce involuntary contractions or spasms of the detrusor muscle, which is a wall of smooth muscle that surrounds the bladder. These spasms cause a sudden and frequent urge to urinate, and could result from conditions like urge incontinence or overactive bladder, as well as from a urinary tract infection or injury.

The most commonly used urinary antispasmodics include antimuscarinic medications like tolterodine, flavoxate, and oxybutynin, as well as beta-3 adrenergic agonists like mirabegron, which can be administered orally or topically. The way these work is by inhibiting the effects of the parasympathetic nervous system on the detrusor muscle, causing it to relax.

Now, side effects commonly associated with urinary antispasmodics include headaches, dizziness, and drowsiness. In addition, clients may experience dry eyes and blurry vision, as well as dry mouth and dry skin. Some clients may also have tachycardia, nausea, vomiting, constipation, urinary retention, as well as anxiety and restlessness. Finally, the most severe side effects of urinary antispasmodics include hyperthermia, confusion, and delirium

As far as contraindications go, urinary antispasmodics should not be given to clients with intestinal or urinary obstruction, as well as those with hypertension or cardiovascular disease. Another contraindication is narrow angle glaucoma, since these medications can worsen the obstruction of aqueous humor drainage. Finally, urinary antispasmodics are contraindicated in clients with myasthenia gravis.

Okay, when caring for your client with an overactive bladder who is prescribed a urinary antispasmodic, first obtain a baseline assessment of your client’s urinary symptoms, such as frequency, urgency, nocturia, and the degree of incontinence they are experiencing. Then, assess your client’s vital signs. Finally, review their laboratory test results, specifically BUN, creatinine, kidney function tests, as well as urinalysis and urine culture.

Be sure your client understands why they have been prescribed this medication and how it will help them with their symptoms. Next, explain that an extended release tablet should be taken whole, never crushed or chewed, and that it can be taken with or without food. If your client is prescribed a transdermal patch, instruct them to apply it on dry, smooth, intact skin that is free of lotions, oils or powders; and recommend the abdomen, hip or buttocks as ideal spots for the patch; in addition, explain the importance of rotating the application site to a different spot each time.